COUNTRY BRIEF: JAMAICA

6 September 2017
                                                       
UNFPA in Jamaica 
 
UNFPA has provided support to the Caribbean since 1969. The sub-regional office is based in Jamaica, which is the largest of the English and Dutch-speaking islands.  Due to the recent realignment of the sub-regional office, there is no longer a specific Jamaica office. However, support for the Jamaica programme is being provided by the sub-regional office.
 
Situational Analysis of Jamaica
 
Jamaica has a population of approximately 2.7 million and is a Caribbean small island developing state.  In 2015, the World Bank estimated Jamaica’s GDP per capita at US $5,138 and the unemployment rate is 13.5%. According to the 2015 Human Development Report, the country has attained a high level of human development and is ranked 99 out of 188 countries on the human development index. 
However, the country is also heavily indebted, and at 130%, has one of the largest debt-to-GDP ratios in the world. Remittances, tourism, and bauxite account for over 85% of foreign exchange. Coupled with reliance on imports, particularly oil, food and consumer goods, this makes the economy acutely vulnerable to exogenous shocks and natural disasters.
 
Demographics
 
There is about 2.7 million persons living in Jamaica (Statistical Institute of Jamaica 2016) and approximately 46% of the population is less than 24 years old.
According to the 2010 Economic and Social Survey of Jamaica, the country is currently at an intermediate stage of the demographic transition. This is evident in the demographic ageing of the population (decreasing birth rates and relatively low death rates.) The effects of the ageing population structure are apparent in the declining 0-14 age group (who represent 29.8% of the population), and the increasing 15-64 age group (61%).  Notably, there is a continued increase of the elderly, 65 years old and over, which is now the fastest growing segment of the population at 9.2%. There are few social services and safety nets available for elderly persons in general, which increases their vulnerabilities to socioeconomic challenges.
 
National Development Framework 
 
The Government of Jamaica is guided by its National Development Plan, Vision 2030 which aims to propel the country towards developed country status by the year 2030. It seeks to promote Jamaica as the place of choice to live, work, raise families and do business and introduces a new paradigm which redefines the strategic direction and priorities for Jamaica. 
 
Key Issues
 
Poverty 
 
The poverty rate in Jamaica stands at 16.5%, having increased in the past two years. The result is that a larger proportion of the population now falls below the poverty line and inequality has risen, in many instances heightening vulnerabilities of the most-at-risk populations, including women and young people. 
 
Maternal mortality 
 
While the country has achieved a relatively high contraceptive prevalence rate of 72% and a low unmet need for family planning of 7.2%, there are still several challenges.
The maternal mortality ratio stands at 89/100,000, a figure which has seen little improvement over the past decade. The major challenges identified in relation to maternal health include quality of care, weak surveillance and monitoring systems and human resource challenges- including a shortage of midwives and nurses. These challenges require addressing the health and education systems and making long-term plans for sustainable change.
 
Teenage pregnancies 
 
The adolescent fertility rate has declined over the past 5 years and now stands at 72/1000. This is still fairly high, and the fact that 18% of all births in Jamaica occur to teenagers is quite alarming. One major challenge is the fact that teen-mothers often drop out of the school system, and have little support from the ‘baby-fathers’ in bringing up their children. This has a double negative effect – on the young mother, who has her opportunities for development truncated; and on the child, who will not receive the benefits that a better-equipped mother could provide in terms of parenting.
 
In the area of adolescent sexual and reproductive health, there are also inconsistencies between policies and the legal framework which impede access to reproductive health services for young people.  This has been linked to unwanted or unintended adolescent pregnancies among young people as well as STI and HIV infection. Additionally, the absence of youth-friendly health services and the cultural barriers to effectively promoting comprehensive sexuality education further impedes young people’s access to reproductive health services.
 
HIV and AIDS 
 
The HIV prevalence rate in the population is 1.7%, with a concentrated epidemic among most vulnerable populations.  For sex workers, the reported prevalence is 9%, and for men who have sex with men, the rate is 32%. Additionally, women and girls are increasingly infected by HIV, and girls in the 15-19 age group are three times more likely to be infected with the virus than young men in the same age group. Stigma and discrimination, particularly in relation to the most-vulnerable populations, prevents them from accessing relevant health information and services.
 
HIV prevention efforts in Jamaica have been extremely robust over the past several years largely due to resources from the Global Fund – which finances over 90% of the national response. With the impending reduction in Global Fund resources due to Jamaica’s middle income classification, there are aggressive attempts by the government to ensure sustainability of the programme.
 
Youth and Violence 
 
Homicidal violence, 77% by the gun, is a leading social problem; it is male on male, youth on youth, poor on poor. Of the youth, aged 15–24, 26.2% males and 7.9% females are illiterate. Unattached youth- those who are not in school, unemployed and not participating in any training course, comprise roughly 30% of the total youth population. About a quarter of unattached youths had attained only a grade 9 level or less of education. Their future prospects for productive and satisfying lives are thus limited. This also makes female youth vulnerable to sexual exploitation and adolescent pregnancy and puts male youth in an extremely vulnerable position, which might lead to participation in criminal gangs.
 
The 2008 Reproductive Health Survey also indicates that approximately 20% of women ages 15-49 had experienced sexual violence. This figure reflects only reported cases, and it is estimated that the actual incidence is significantly higher.
 
Migration 
 
Migration continues to impact Jamaica’s population growth and structure as well as other socio-economic factors.  Some estimates indicate that as many Jamaicans may currently be living outside the country as those who are living within it. The emigration of skilled persons has had tremendous impact on the workforce, most notably in the social sectors such as health and education where there is a shortage of qualified nurses and teachers.
 
While remittances provide a tremendous source of foreign exchange for Jamaica, migration, if not adequately addressed, can undermine the country’s ability to achieve sustainable development.
Key Achievements in the Jamaica programme 2012-2016
 
UNFPA has been working with several government and civil society partners including the Ministries of Health, Education and Youth, the Planning Institute of Jamaica, the Statistical Institute of Jamaica, Women’s Centre of Jamaica Foundation and the Family Planning Association of Jamaica.  During the fifth country programme cycle which spanned the period 2012-2016, the Jamaica programme focussed on the main areas of UNFPA’s mandate: (i) Sexual and Reproductive Health (ii) Population and Development and (iii) Gender equality.
 
UNFPA in Jamaica has supported programme interventions geared towards improving adolescent sexual and reproductive health, promoting maternal health, preventing gender-based violence and strengthening the linkages between population and development.
 
Selected key achievements in these areas include the following:
 
Poverty Reduction
UNFPA has collaborated with the National Family Planning Board (NFPB) to promote family planning and contraceptive use, which reduces fertility rate and has a direct impact on poverty reduction. UNFPA has donated over US $100,000 worth of contraceptives (including male condoms, female condoms and injectables) to the NFPB for free distribution in the public sector. The rationale behind promoting free distribution of reproductive health commodities is to ensure that they are accessible to the poor and most vulnerable individuals in society, with a particular emphasis on women.
 
Improving Maternal Health 
UNFPA has supported the Ministry of Health in developing a National Strategic Plan on Maternal Health. The Strategic Plan outlined the priority areas for strengthening maternal health in Jamaica, including health promotion and protection; strengthening health sector policy regarding human resources and staffing of the sector; quality of care issues such as procuring key medical equipment and developing protocols for the administration of emergency obstetric care; strengthening surveillance systems including improving documentation, information systems and timeliness of mortality reviews.  
 
UNFPA also supported the Ministry of Health in developing an updated Situation Analysis of Maternal Health in Jamaica in 2012. This analysis highlighted the priority areas that need to be addressed in order to reduce the maternal mortality rate in Jamaica.
 
UNFPA collaborated with the Ministry of Health in developing a project proposal to accelerate progress on maternal and child health for submission to the European Union. The proposal was approved and an amount of €22 million has been committed to the Government through PROMAC, in a comprehensive programme with the health sector which began in 2014.
 
In collaboration with the Ministry of Health Jamaica, CARICOM, the Caribbean Network of First Ladies and other partners, a commitment for action was submitted to the Clinton Global Initiative “Every Caribbean Woman: Every Caribbean Child” in 2015, which addresses reduction of adolescent pregnancy, prevention of cervical cancer and prevention of mother-to-child transmission. The Prime Minister of Jamaica has agreed to present the commitment at the Clinton Global Initiative Annual Meeting in September 2016.
Since 2014, UNFPA has been collaborating with the Ministry of Health to develop a National Sexual and Reproductive Health Policy.
 
Promoting Access to Reproductive Health, Information and Services for Adolescents
UNFPA has collaborated with the Ministry of Health to develop a document that analyses the ‘Legal and Policy Environment for Promoting Adolescent Sexual and Reproductive Health in Jamaica.’ This document provides recommendations regarding amendments to laws, policies and procedures in an effort to promote access to comprehensive, age-appropriate sexual and reproductive health information, education and services for young people. This document has been used by the Minister of Health in engaging the justice, youth and education sectors regarding legislative amendments. A Cabinet submission is currently being developed to address this issue.
 
UNFPA has also been collaborating with the Ministry of Education in providing content and resource materials for the Health and Family Life Education (HFLE) curriculum. More specifically, UNFPA has provided technical inputs and has developed content on pregnancy and life skills for young people, which has been incorporated into the revised curriculum.
 
Re-integration of Adolescent Mothers into the formal education system
In collaboration with the Ministry of Education and the Women’s Centre of Jamaica Foundation (WCJF), UNFPA has supported the development of a ‘Policy on the Re-Integration of Adolescent Mothers into the Formal Education system’, which was approved by Cabinet in May 2013. This Policy mandates schools to accept adolescent mothers into the school system after having their babies - thereby allowing the girl to complete her formal education.
UNFPA has also promoted the Women’s Centre model to various countries across the world, resulting in an exchange visit of the First Lady of Burkina Faso and the Minister of Gender Affairs of Burkina Faso in June 2012.
 
Preventing HIV and AIDS
In an effort to strengthen the integration of HIV and reproductive health services, UNFPA has supported the Government of Jamaica in establishing a Sexual and Reproductive Health Authority. This entity has been formed as a result of the integration of the National HIV Programme and the National Family Planning Board. This Authority will promote integrated services for reproductive health. 
 
UNFPA has provided technical and financial support to the SRH/HIV Integration process and is currently working with the Sexual Health Authority to improve the supply and accessibility of reproductive health commodities in the country. The implementation of HIV/AIDS interventions in Jamaica has been fast-tracked and over 60% of the HIV programme budget has been allocated for this purpose.
 
Preventing Gender-Based Violence
UNFPA has been actively working with the Government of Jamaica to address the prevention of sexual violence through public awareness sessions and community interventions, as well as strengthening systems of support for survivors of violence.
 
UNFPA has collaborated with the Bureau of Women’s Affairs to train over 250 young men as peer educators in preventing gender-based violence in their communities. Male action networks were subsequently formed by these young men at the community level in order to provide peer-to-peer education on violence prevention.  In addition to this training on gender-based violence, the young men were also provided with skills training around computer repairs and culinary arts. The skills training component was deemed as being critical in allowing the men to develop an income-generating skill.
 
UNFPA is currently collaborating with Eve for Life and other agencies of the United Nations system to support the ‘Nuh Guh Deh Campaign’ geared towards raising awareness around sexual abuse of young girls.
 
Highlighting the Impact of Population Dynamics on Development
 
UNFPA has collaborated with the Planning Institute of Jamaica in the development of a National Policy and Plan of Action for International Migration and Development. The Policy seeks to identify strategies for harnessing the full development potential of migrants, with a focus on priority areas including (1) Governance and Policy Coherence; (2) Data, Research and Information Systems; (3) Diaspora and Development; (4) Labour Mobility and Development; (5) Remittance and Development; (6) Human Rights and Social Protection; (7) Return and (Re) Integration and (8) Family, Migration and Development.
 
As part of a regional activity and in collaboration with UN ECLAC and the United States Census Bureau, with funding from the Caribbean Development Bank, the capacity of national statisticians was built in Demographic Analysis and Population Projections using DAPPS.
 
Technical support is currently being provided to STATIN for the preparatory phase of the 2020 Census Round and to the Planning Institute of Jamaica for the development of a national Population Situation Analysis and Review of the Population Policy.
Opportunities and  Challenges
 
The relationship that UNFPA has with national partners is very positive and meaningful and these partnerships have served to facilitate the advancement of UNFPA’s agenda in Jamaica.  However, there have been increased objections in the public domain particularly from faith-based organizations on the issue of Comprehensive Sexuality Education in schools and access to the sexual and reproductive services and information and promotion of reproductive rights for key population including adolescents. These objections have served to constrain progress on some areas of UNFPA’s mandate.
Findings from the Self-Assessment of the 2012-2016 Multi-Country Programme indicate that UNFPA has a comparative advantage in the Caribbean in its area of work and credibility with governments and regional institutions including CARICOM and the OECS. Thus, UNFPA has a key role to play as an advocate and catalyst for the implementation of the ICPD PoA in Jamaica. The new government is supportive of UNFPA’s work as demonstrated in the partnership on the Global Clinton Foundation Initiative. Furthermore, the 2020 Census Round and implementation of the UN Multi-Country Sustainable Development Framework and the CARICOM Integrated Strategic Framework to Reduce Adolescent Pregnancy will provide the opportunity to deepen collaboration and cooperation with the Government of Jamaica.